1. The OPAT experience in Dudley Kate Owen & Nichola Hughes-Gordon The OPAT experience in Dudley Kate Owen & Nichola Hughes-Gordon

2. Dudley Group of Hospitals Outpatient Intravenous Antibiotic Therapy Kate Owen (District Nurse Specialist Practitioner) Nichola Hughes-Gordon (Acute medical nurse)

3. Dudley OPAT Service Joint project between hospital and community staff Launched in January 2012 Replaced the original community IV model for treating cellulitis

4. Dudley OPAT Service The Team: Hospital Staff Acute Medical Unit consultant and registrars Acute Medical Unit nurses Pharmacy Microbiology Community Staff Virtual IV team of community nurses Community clinic Advanced Nurse Practitioners and senior nurses with NMP

5. Policies and Pathways Overarching OPAT policy Strict inclusion criteria Ratified specific pathways for: Cellulitis, Complex UTI (including ESBL and pyelonephritis) Development of new pathways: Diabetic foot ulcer and osteomyelitis Bronchiectasis and pseudomonas chest infections Future pathways Discitis, Septic arthritis, Infective endocarditis,

6. Performance Since January 2012, Over 700 bed days saved, more capacity in hospital Over 90 patients treated with high level of patient satisfaction, only 2 patients readmitted

7. Diagnosis

8. A Patient Journey – hospital Patient diagnosis confirmed and needs IVAB Referred to OPAT Hospital team Patient cannulated First dose of IVAB administered TTO prescribed Referred to Community Nurses

9. Patient journey continues in the community Accepted referral by community nurse Patient housebound Patient receives IVAB Bloods taken day before review Patient reviewed community or hospital clinic Patient continues treatment or discharged Patient can attend clinic

10. Success! Transferring community nursing services to the acute trust has strengthened the working relationship between community and acute care Excellent example of acute and community working together to benefit patient care, reduce hospital admissions and facilitate early discharge Support from senior management and AMU consultants Project management team set up with key professionals to develop policy and clinical pathways Enthusiastic, “can do” attitude

11. Patient Satisfaction A survey was sent to patients and we received a 43% response rate 100% stated they were satisfied with the service The level of support during treatment was rated as excellent by 71% of respondents and 29% stated it was very good “All the staff were brilliant at their job and always took time to talk”

12. Challenges Embedding the referral process for OPAT Communication to all of the staff on EAU / ward nurses / doctors Vascular access for some patients however the use of PICC, Tunnelled Central Lines, Midlines and Winged Infusion Devices has helped

13. Future Challenges Further pathways Further education of all staff IT challenges – database, electronic authorisation and recoding administration of doses Funding for the future – business case Increasing capacity within the community Developing advanced nursing skills and NMP

14. What we have learnt so far Communication is key Regular meetings and updates with the OPAT team, to the patients and relatives, and to other staff members within the hospital and community setting Keep the team small: experienced, regular team members Keep building upon the success: new pathways Ensuring constant feedback: boost morale, high levels of patient satisfaction and reduced number of bed days.

15. Conclusion Excellent working relationship between hospital and community staff Safe working, pathways developed, success going from strength to strength!